Iowa Pediatric Asthma & Allergy

Patient Forms to Be Completed

Please print off the appropriate forms below, complete them, and return them to our office. This will help reduce the wait time for your appointment.

It is very important for Dr Sheets' on-going care of your child to be thorough and accurate with your information. We appreciate the opportunity to partner with you in the health of your child.

You can email the completed forms to info@iowapedsasthma.com or bring it with you to your visit.

PATIENT RELEASE - Release Records - Staying with Dr. Sheets
Complete this form to have your child's medical records released to University of Iowa Hospital (continue as a patient of Dr. Sheets.)
IPAA release to UIHC.pdf
Adobe Acrobat document [301.8 KB]

PATIENT RELEASE - Release of Medical Records
Use this form if you would like your medical records released to a different provider other than Dr. Sheets.
Patient Release to Another Provider.pdf
Adobe Acrobat document [303.6 KB]

NEW Patient Information
Complete this form if your child has never seen Dr Sheets before.
New patient info.pdf
Adobe Acrobat document [78.4 KB]

RETURNING Patient Information -First Time in New Office
Complete this form if you have seen Dr Sheets before however, you have not been to our new clinic in West Des Moines yet.
Returning patient info-web.pdf
Adobe Acrobat document [72.3 KB]

FOLLOW-UP Patient Information
Complete this form is your child has seen Dr. Sheets at his new location in West Des Moines.
Follow-up Patient Info.pdf
Adobe Acrobat document [42.3 KB]